Abstract
Purpose
To report a case with focal choroidal excavation (FCE) accompanied by type 2 choroidal neovascularization (CNV), in which the CNV was successfully treated with intravitreal aflibercept, after which the FCE was no longer detectable.
Observations
A conforming type of FCE was detected in the left eye of a 34-year-old Japanese man who visited our hospital for a second opinion regarding treatment for his right eye. Three months later, type 2 CNV developed in the region corresponding to the FCE in the left eye. After treatment with intravitreal aflibercept, the CNV disappeared, and FCE was no longer detected. No recurrence has been observed in the 12 months following the treatment.
Conclusions and Importance
Although the etiology of FCE has not been fully elucidated, we discussed the mechanisms underlying its occurrence, its association with CNV, and the disappearance of both conditions after treatment.
Highlights
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Focal choroidal excavation (FCE) is a relatively rare clinical entity.
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The etiology of FCE has not yet been fully elucidated.
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We experienced FCE disappearance after treatment of choroidal neovascularization.
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We speculate on the mechanism of FCE development and disappearance in this case.
1
Introduction
Focal choroidal excavation (FCE), first described by Jampol et al., in 2006, is a relatively rare clinical entity according to optical coherence tomography findings. FCE is characterized by a localized area of excavation of the choroid without any evidence of either posterior staphyloma or scleral ectasia. In the conforming type of FCE, the outer segments of the photoreceptors are attached to a concave retinal pigment epithelium (RPE), while in the nonconforming type, there exists a separation between the photoreceptor tips and the RPE. In most cases, FCE is relatively stable; however, it can be associated with comorbidities, such as central serous chorioretinopathy and age-related macular degeneration (AMD), including polypoidal choroidal vasculopathy. Additionally, it has recently been proposed that FCE should be included in the pachychoroid spectrum. ,
Here, we report a case with FCE accompanied by choroidal neovascularization (CNV) in a 34-year-old Japanese man. In this case, CNV was successfully treated with intravitreal aflibercept (IVA; Eylea®, Leverkusen, Germany), after which the FCE was no longer detected.
2
Case report
The patient visited our hospital to obtain a second opinion about treatment for his right eye. He had noticed decreased vision in the right eye 3 months earlier. At the first visit, his best-corrected visual acuity (BCVA) was 20/70 in the right eye (spherical equivalent: 4.375 diopters) and 20/16 in the left eye (spherical equivalent: 3.875 diopters). Cicatrized subretinal neovascularization without subretinal fluid or intraretinal cystic changes was noted in the right eye, whereas the conforming type of FCE was detected 500 μm temporal to the foveal in the left eye ( Fig. 1 ). He had smoked cigarettes for 15 years. There was no remarkable family medical history. General examination did not reveal any systemic abnormality.
Three months later, he re-visited our hospital due to decreased vision in the left eye. The BCVA had decreased to 20/30 in the left eye. Ophthalmic examination confirmed type 2 CNV with subretinal fluid in the region corresponding to the FCE in the left eye ( Fig. 2 ). After obtaining informed consent for the procedure, IVA was performed monthly for 3 months in the left eye. The study was conducted with the approval of the Institutional Review Board of Hayashi Eye Hospital and adhered to the tenets of the Declaration of Helsinki.
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